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New inhalers, I'm confused, can anyone enlighten me?


I got a refilled prescription today and was moved from my usual beclametasone on to QVAR, but it doesn't fit my large spacer so I handed it back. Nurse then got doc to prescribe clenil modulite as it will fit aerochamber and my large spacer as I prefer my large spacer when my chest is bad.

She said that they've changed because of them having to be CFC free, but I was sure that my usual run of the mill beclametasone was already CFC free. She also said it's supposed to be better because the molecules are smaller and it gets into your lungs easier.

And what idiot would make a replacement that doesn't fit the spacers available.

I was told that QVAR is meant for adults and clenil modulite is meant for kids. So now I am on the kids med.

Sounds like change for changes sake to me. Gonna check old inhalers when I go to bed.


21 Replies

Clenil and Qvar are both CFC free preventers (becatide that you may have been on before is not CFC free and I believe that it is no longer avaliable) I am also led to believe that Clenil and Qvar are not interchangeableas the doses are not the same on each so you have to be careful there.

I have Clenil and as far as I am aware it is used in both adults and kids.

Hopethat is of some help...




when I got my last prescription of beclametasone I was too given clenil. I'm 16 so I think it is fine for both adults and children.



Clenil is beclometasone

Hi, I'm newly diagnosed with asthma (though I had it 3 years ago when pregnant). I have been given Clenil Modulite - when I examined the canister, I noticed that the actual drug name is beclometasone dipropionate - I think CM is the brand name. I think when I had asthma before, I had the same drug but it was called something like ""becotide"" or maybe ""becoforte"". I think it's just like lots of different manufacturers making ibuprofen and calling it something else - like neurofen... same drug, same effect.. another name.

""A rose by any other name would smell as sweet.



Just a couple of pointers..

Preventer inhalers come in diferent strengths.

Beclomethasone used to be available as becotide 50, becotide 100 and I think Becloforte which was 200 mg.

Beclomethasone therefore should be available in different doses as clenil and QVAR. See what it says on the box.

Regarding the spacer issue. If it is a Volumatic barrage balloon shaped object then that is made by Allen & Hanbury, primarily for their inhalers such as ventolin, seretide & Becotide etc. Other brand inhalers sometimes fitted the ridgid hole so there wasn't an issue there.

There are other spacers available that although are smaller are just as efficient but also they have soft insertion holes for the inhaler to fit and will accept virtually most inhalers. Able Spacer is one such spacer.

Hope this helps!



just as an add on to kate's message- aerochamber spacers are soft too and i find them great u can carry it in ur handbag as its small n discrete but i find it just as effective as my large volumatic spacer which is too big for this even wen it is taken apart. The only benefit to volumatic is its much much easier to clean!!

Stay wrapped up warm everyone! Lv kat Xx


Just to clarify, although I think most of the points have already ben made:

""Old"" beclometasone inhalers used CFC-based propellants, and due to the introduction of the Montreal Protocol (which aims to reduce/eliminate the world useage of CFCs) all manufacturers have had to move to non-CFC propellants now. The two ""new"" beclometasones are Clenil and Qvar. Clenil's particles are roughly the same size as the ""old"" beclometasone, whereas Qvar's are much smaller. As such, Qvar is twice as ""strong"", dose for dose, when compared to Clenil and ""old"" beclometasone.

Both medicines can be used for both adults and children alike.

Spacers such as the Aerochamber and the Able spacers fit most inhalers, including both of the ""new"" beclometasones.





Anyone had problems with the reliability and ability for these to supply the advertised amount of doses?


Bumped up for shiparrivin...


thanks for making this thread known to me!

Anyone whose used the clenil modulite - did you find it hard to use? of course i dont mean action or instruction wise - but rather with the strengh of the discharge of the clenil - if you get what i mean?

- cause I've tried the clenil modulite after being put on that after beclometasone was discontinued. I was told the clenil IS supposed to be practically the same thing as beclometasone (with steroid trace) however when I used it I felt it ddnt 'do' for me, I hated the way the inhaler worked and it seemed to spray an odour as well - I got paranoid i was making a fuss out of nothing, but i was annoyed that they'd MADE me change from the beclometasone - like, why wasnt I asked to vote wether it was discontiued?

so I asked my doctor for an alternative to the clenil and he pescribed me salmeterol (/serevent) inhaler. This came in a green casing as compared to the previous brown casings of becoforte, becotide, beclometasone and even clenil modulite - plus it has no steroid in it. I dont know if it was this non-steroid factor, but when using the salmeterol my throat felt dry and sore and i became bloated like it was affecting my metabolism or something.

at the moment i've switched back to the beclometasone which i'm using the last off before it becomes extinct.

anyone have any advice? e.g.

A) are there adverse 'come down' effects from constantly using the beclometasone with trace steroid in it and then suddenly switching to a non-steroid inhaler???

B) does anyone have any info on how the inhalers effect the metabolism?

C) does the QVAR have steroid trace in it? and whats the usage like?

D) has anyone else had problems with the clenil modulite?




Clenil Modulite and Beclometasone Dipropionate are the same item. Just one is the generic name and the other chemical name. I was on this originally when diagnosed with asthma, and found it gave me a sore throat, the use of a spacer, regardless of dosage is what I discovered the best way to prevent this.

The difference you notice, is more likely to be the change in propellant. I can't comment on this as I've not use a CFC inhaler.

Salmeterol, is not a steroid replacement, but an addition to the inhaled steriods, its a long acting bronchial dilator (I used that as well), and it must not be used without the addition of the steroid inhaler (serious side effects have been reported in these cases - increased death rates)

I now use seretide, which is a combination of a steroid and salmeterol, much better, still use the spacer, but don't get the sore throat the same, less items to inhale I guess.

Please read the precautions below for salmeterol/serevent - taken from the prescribing notes issued to doctors.

4.4 Special warnings and precautions for use To the top of the page

The management of asthma should normally follow a stepwise programme and patient response should be monitored clinically and by lung function tests.

Salmeterol should not be used (and is not sufficient) as the first treatment for asthma.

Salmeterol is not a replacement for oral or inhaled corticosteroids. Its use is complementary to them. Patients must be warned not to stop steroid therapy and not to reduce it without medical advice even if they feel better on salmeterol.

Salmeterol should not be used to treat acute asthma symptoms for which a fast and short-acting inhaled bronchodilator is required. Patients should be advised to have their medicinal product to be used for the relief of acute asthma symptoms available at all times.

Increasing use of short-acting bronchodilators to relieve asthma symptoms indicates deterioration of asthma control. The patient should be instructed to seek medical advice if short-acting relief bronchodilator treatment becomes less effective or more inhalations than usual are required. In this situation the patient should be assessed and consideration given to the need for increased anti-inflammatory therapy (e.g. higher doses of inhaled corticosteroid or a course of oral corticosteroid). Severe exacerbations of asthma must be treated in the normal way.

Although Serevent may be introduced as add-on therapy when inhaled corticosteroids do not provide adequate control of asthma symptoms, patients should not be initiated on Serevent during an acute severe asthma exacerbation, or if they have significantly worsening or acutely deteriorating asthma.

Serious asthma-related adverse events and exacerbations may occur during treatment with Serevent. Patients should be asked to continue treatment but to seek medical advice if asthma symptoms remain uncontrolled or worsen after initiation on Serevent.

Sudden and progressive deterioration in control of asthma is potentially life-threatening and the patient should undergo urgent medical assessment. Consideration should be given to increasing corticosteroid therapy. Under these circumstances daily peak flow monitoring may be advisable. For maintenance treatment of asthma salmeterol should be given in combination with inhaled or oral corticosteroids. Long-acting bronchodilators should not be the only or the main treatment in maintenance asthma therapy (see Section 4.1).

Once asthma symptoms are controlled, consideration may be given to gradually reducing the dose of Serevent. Regular review of patients as treatment is stepped down is important. The lowest effective dose of Serevent should be used.

Salmeterol should be administered with caution in patients with thyrotoxicosis.

There have been very rare reports of increases in blood glucose levels (see Section 4.8) and this should be considered when prescribing to patients with a history of diabetes mellitus.

Cardiovascular effects, such as increases in systolic blood pressure and heart rate, may occasionally be seen with all sympathomimetic drugs, especially at higher than therapeutic doses. For this reason, salmeterol should be used with caution in patients with pre-existing cardiovascular disease.

Potentially serious hypokalaemia may result from β2 agonist therapy. Particular caution is advised in acute severe asthma as this effect may be potentiated by hypoxia and by concomitant treatment with xanthine derivatives, steroids and diuretics. Serum potassium levels should be monitored in such situations.

Data from a large clinical trial (the Salmeterol Multi-Center Asthma Research Trial, SMART) suggested African-American patients were at increased risk of serious respiratory-related events or deaths when using salmeterol compared with placebo (see section 5.1). It is not known if this was due to pharmacogenetic or other factors. Patients of black African or Afro-Caribbean ancestry should therefore be asked to continue treatment but to seek medical advice if asthma symptoms remained uncontrolled or worsen whilst using Serevent.

Patients should be instructed in the proper use of their inhaler and their technique checked to ensure optimum delivery of the inhaled medicinal product to the lungs.

As systemic absorption is largely through the lungs, the use of a spacer plus metered dose inhaler may vary the delivery to the lungs. It should be noted that this could potentially lead to an increase in the risk of systemic adverse effects so that dose adjustment may be necessary.


clenil v qvar

These are both the same drug but simply different potencies due to the molecule size and plume. Due to the fact that some brands of cfc free beclametasone are not equipotent, it is now recommended that GP's prescribe the inhaled steroids by the brand name ( ie Qvar, Clenil Modulite) to ensure that you always get the same type of inhaler (and therfore correct potency). I have heard a few patients comment on the taste of Clenil but there are lots of medicines that don't taste so good and when needs must... just gargle and have a drink after taking it.

Qvar, if i am correct, is not licensed for under 4yrs (used to be for over 12yr only)but Clenil Modulite is licensed for ANY age.



cleaning spacer device

I have a similar problem to you lot and have had to switch to clenil modulite even though I was happier with the old steroid. Because the new propellant wrecks my throat I've had to switch to using a spacer which I can't clean. I folllow the instructions and there is a layer of powder around the edge that will just not come off. I am actually on my third spacer now in the last few months because I was told by the woman at Glaxo that it was probably faulty. Is there any way of getting it properly clean? I just soak it in water with detergent and supposedly it should just come off but it doesn't. The best anyone in my surgery can suggest is switching to a dry powder and I'm having problems with that too. Montreal protocol. Forum guidelines stop me from saying what I think of it........


Hi Willstevens

Your thoughts on the Montreal protocol are probably similar to mine. I'm all for supporting the environment but I think that medical stuff should have been exempt.

Also a publicity campaign should have been undertaken so that we would have known about the changes before they actually affected us. I'd been in to see my doc and he's said nothing it was only on collecting my prescription that I realised anything had changed. I was pished off that he hadn't discussed it with me.

Things are sorted now but it's the principle. I take lots of meds for different complaints and expect to be treated as an equal and be given choices about my treatment.

I'll stop moaning now.



Cleaning spacers - try a tooth brush or even the dish washer - I used to pop mine in the dishwasher when at home but not sure if recomended!! Regarding the deposits, if it isn't too much and doesn't block the spacer I wouldn't worry about it.

Perhaps the new propellants cause the blockages???

Regarding the Montreal protocol, this has been in place since 1987.

It only seems to be the beclomethasone based inhalers that seem to be causing these problems. The first to go over was ventolin to the new Evohaler, then the newer maintream drugs such as flixotide, Seretide and serevent. Perhaps as becotide (Beclomethasone) was an older type inhaled steroid, it was dropped by Glaxo as an aerosol and is only made as Becodisks, powder version now.

It is now made as an aerosol MDI inhaler by other companies to their own recipes. Flixotide (Fluticasone) is thought to be a better drug but is probably more expensive that beclomethasone so beclomethasone continues to be prescribed.

the drugs companies have had years to sort this out and there has been publicity about it. I am sorry but I am for the Montreal Protocol working as I work in the field of Ecology!



If the Montreal Protocol was so important then things should have changed faster than 20 years. I am all for green issues but there are far bigger ones to be sorted than changing medical inhalers 20 years after an agreement. In the 20 years I just assumed that the propellant had changed like the one in Ventolin did.

My biggest gripe was and is that doctors should be giving us choices and letting us make decisions and keeping us informed when changes have to be made. It's not much to ask to play a part in my own treatment rather than being the traditional passive recipient.



Certainly in our practice when the changes had to be made, all patients had a letter sent out explaining it - and I believe they also had a leaflet from the pharmacy with their new script.


All I got from my practice was one printed page hidden in my pile of repeat forms saying suggested change and the name of the drug and to speak to the pharmacist if I had any questions. But I didn't know I had that until after going through a load of grief with the surgery.

I happened to check my meds as normal when I got back in the car at the chemist and found the new drug then, had a look at it and then took it back in and handed it back because of the round end on it (I'd done the same when they had taken it on themselves to give me the breathe activated inhalers as they don't work through the spacers). I went down to the surgery and eventually got some sense out of them and came away with a prescription for the clenil modulite and it seems to be working fine. If my doc had shown me the 2 types of inhaler when I was in with him that very afternoon we could have solved the problems before they occurred.

In the past I had to fight with my psychiatrist to be given choices about meds and time to do my own research.

It would be nice if being offered a choice became a part of life when receiving treatment. Not everyone would wish to take it up but there must be more people like me who wish to have choices, when you have 12 items on repeat (4 being for asthma) it can feel like you have no control, and asking for choices is a way of being able to take back some control.

I know that as docs you train for years but when you live with a condition/s you do get to know your own body, treatments etc. and know what you are willing to live with and tolerate. In the psych field there is a term 'expert by experience'.


I suppose I have a reasonably uncommon perspective, being both a doctor *and* living with a condition. However, no doubt many will be aware of a constant barrage of publicity from NuLabour regarding ""Choice"" as a big agenda in the NHS at the moment. It also forms part of training, but I guess different doctors simply operate differently and it may depend in part what ""kind"" of doctor your GP is! :) - oh, and when they trained - generalising completely, of course, but older GPs may well have a more ""paternalistic approach"", simply because they underwent a more traditional style of training.

Put simply - yes, I agree with you Jen, decisions should be a joint thing, but the application of this principle can be variable.


bump for blue jam

soom of this is relevant to what clenil is x


Ta again


It's like inhaling methylated spirits + question

I am finding clenil modulite extremely unpleasant to use because of the puff of alcohol. When I first tried it, I gagged and retched and was completely unable to use it. My throat just seemed to close. My doctor has now given me a spacer and with this I can just about use the inhaler. But it is still deeply unpleasant and makes using my inhaler something I have to make myself do.

My question is: does the medical profession recognise that this is a problem, and are the drug companies working on better alternatives to the Becotide etc inhalers, which worked so well?


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